NICE appraisals should be everybody's business

doi:10.1136/bmj.39190.420081.94

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Jane Wells, public health physician1,
Claire Cheong-Leen, head of public health policy and development2

¹Berkshire West Primary Care Trust, Newbury RG14 1BZ
²Thames Valley Priority Setting Unit, Oxford OX4 2GX

Correspondence to: J Wells Jane.Wells{at}berkshire.nhs.uk

Accepted 6 March 2007

When Newbury and Community Primary Care Trust appealed against NICE's decision on Herceptin, it was the first to do so. Jane Wells and Claire Cheong-Leen explain the process and why other trusts should make their voices heard in appraisals of new treatments

Publicly funded health services should aim to provide the best possible health care within the available budget. With finite resources and demand for health care growing both in quantity and cost, they are faced with increasingly difficult decisions about the services they should provide. They must balance their responsibilities to the whole population and to individual patients; consider the need for preventive, therapeutic, and long term care; weigh the merits of new against established treatments; and deliver the services they wish to provide as well as those that are mandatory. In England, primary care trusts are mainly responsible for these decisions. Following the latest NHS reorganisation there are now 152 primary care trusts, each of which commissions health services for a population of up to about 600 000.

NICE and the NHS

NHS provision is fundamentally influenced by the National Institute for Health and Clinical Excellence (NICE), which produces national guidance on health technologies, public health, and clinical practice.1 NHS organisations in England and Wales are required to implement NICE guidance on new technologies within three months of issue. A large proportion of the treatments that NICE appraises are drugs, many of them expensive, and most appraisals result in a recommendation that they should be used. NHS organisations must then give funding of these new treatments precedence over other interventions, which can affect their ability to provide other services.

NICE appraisals consider the cost effectiveness of each intervention, with a threshold of about £30 000 (€44 000; $60 000) per quality adjusted life year (QALY). However, the appraisals do not explicitly take into account the …